上腔静脉闭塞锐性开通的导丝穿出血管重回真腔并发症2例

锐性开通重建血管是血液透析患者上腔静脉闭塞的主要处理措施之一,术中严重并发症包括纵隔血肿、上腔静脉破裂、心脏压塞等。而导丝穿出血管重回真腔这一并发症并未得到重视,现报道本中心上腔静脉闭塞锐性开通中出现导丝穿出血管重回真腔的2例病例,并探讨预防方案。     

内皮抑素在大鼠腹膜的表达及其与腹膜血管新生的关系

Objective To investigate the expression of endostatin (ES) in rat peritoneum and its association with peritoneal neoangiogensis. Methods Thirty-two male SD rats were randomly divided into 4 groups: normal control rats (C group), renal failure without PD rats (non-PD group), rats dialyzed with 1.5% PD solution (1.5% PD group) and 4.25% PD solution (4.25% PD group). After regular PD for 28 days, mRNA and protein expression of ES in peritoneal tissues of each group were detected by RT-PCR and immunohistochemistry respectively. Microvessel density (MVD) of peritoneal tissue was assessed using immunohistochemistry with CD34 monoclonal antibody. Results ES mRNA was expressed in each group, 0.47±0.05 in C group, 0.45±0.04 in non-PD group, 0.46±0.04 in 1.5%PD group, 0.47±0.03 in 4.25%PD group, and no significant differences were found among groups. Score of ES protein expression was O in C group, 2 in non-PD group, 4 in 1.5%PD group, and 9 in 4.25%PD group. MVD was 3.13±1.13 in C group, 5.13±1.14 in non-PD group, 9.00±1.51 in 1.5%PD group, 10.75±1.83 in 4.25%PD group, and significant differences were found among groups. Conclusion Uremia circumstance and non-physiological compatibility peritoneal dialysate can increase ES protein expression and MVD, which may participate in and have effects on the course of peritoneal neoangiogensis.     

内皮抑素在大鼠腹膜的表达及其与腹膜血管新生的关系

Objective To investigate the expression of endostatin (ES) in rat peritoneum and its association with peritoneal neoangiogensis. Methods Thirty-two male SD rats were randomly divided into 4 groups: normal control rats (C group), renal failure without PD rats (non-PD group), rats dialyzed with 1.5% PD solution (1.5% PD group) and 4.25% PD solution (4.25% PD group). After regular PD for 28 days, mRNA and protein expression of ES in peritoneal tissues of each group were detected by RT-PCR and immunohistochemistry respectively. Microvessel density (MVD) of peritoneal tissue was assessed using immunohistochemistry with CD34 monoclonal antibody. Results ES mRNA was expressed in each group, 0.47±0.05 in C group, 0.45±0.04 in non-PD group, 0.46±0.04 in 1.5%PD group, 0.47±0.03 in 4.25%PD group, and no significant differences were found among groups. Score of ES protein expression was O in C group, 2 in non-PD group, 4 in 1.5%PD group, and 9 in 4.25%PD group. MVD was 3.13±1.13 in C group, 5.13±1.14 in non-PD group, 9.00±1.51 in 1.5%PD group, 10.75±1.83 in 4.25%PD group, and significant differences were found among groups. Conclusion Uremia circumstance and non-physiological compatibility peritoneal dialysate can increase ES protein expression and MVD, which may participate in and have effects on the course of peritoneal neoangiogensis.     

内皮抑素在大鼠腹膜的表达及其与腹膜血管新生的关系

Objective To investigate the expression of endostatin (ES) in rat peritoneum and its association with peritoneal neoangiogensis. Methods Thirty-two male SD rats were randomly divided into 4 groups: normal control rats (C group), renal failure without PD rats (non-PD group), rats dialyzed with 1.5% PD solution (1.5% PD group) and 4.25% PD solution (4.25% PD group). After regular PD for 28 days, mRNA and protein expression of ES in peritoneal tissues of each group were detected by RT-PCR and immunohistochemistry respectively. Microvessel density (MVD) of peritoneal tissue was assessed using immunohistochemistry with CD34 monoclonal antibody. Results ES mRNA was expressed in each group, 0.47±0.05 in C group, 0.45±0.04 in non-PD group, 0.46±0.04 in 1.5%PD group, 0.47±0.03 in 4.25%PD group, and no significant differences were found among groups. Score of ES protein expression was O in C group, 2 in non-PD group, 4 in 1.5%PD group, and 9 in 4.25%PD group. MVD was 3.13±1.13 in C group, 5.13±1.14 in non-PD group, 9.00±1.51 in 1.5%PD group, 10.75±1.83 in 4.25%PD group, and significant differences were found among groups. Conclusion Uremia circumstance and non-physiological compatibility peritoneal dialysate can increase ES protein expression and MVD, which may participate in and have effects on the course of peritoneal neoangiogensis.     

维持性血液透析患者QTc间期与人体成分分析的相关性研究

目的:研究维持性血液透析(MHD)患者QTc间期与人体成分之间的相关性。方法:选取2020年1-12月在郑州大学第一附属医院肾脏内科住院治疗的305例MHD患者,其中QTc间期正常组与延长组分别为183例(60%)及122例(40%)。在周中透析日透析前利用多频生物电阻抗人体成分分析仪进行人体成分分析,记录透析前水负荷(OH)、脂肪组织指数(FTI)、瘦肉组织指数(LTI)、人体总水分(TBW)、细胞外液(ECW)、细胞内液(ICW)、体细胞质量(BCM)、体质量指数(BMI),同期进行实验室检查、心电图检查。根据QTc间期将患者分为QTc间期延长组(QTc间期>440ms)及QTc间期正常组(340ms≤QTc间期≤440ms),比较两组间各临床指标及人体成分分析指标的差异,分析各临床指标、人体成分分析指标与QTc间期的相关性,采用逐步多元线性回归分析MHD患者QTc间期延长的相关影响因素。结果:与QTc间期正常组相比,延长组患者FTI增加,LTI、TBW、ICW、BCM下降(P<0.05),血小板计数(PLT)、血钙(Ca)相对更低,C反应蛋白(CRP)显著升高(P<0.05)。相关性分析显示,QTc间期与CRP、FTI呈正相关(P<0.05),与Ca、LTI、TBW、ICW、BCM呈负相关(P<0.05)。以QTc间期为因变量,以CRP、Ca、LTI、FTI、TBW、ICW、BCM为自变量进行逐步多元线性回归分析,结果显示,高FTI、低Ca、高CRP为QTc间期延长的独立危险因素(P<0.05)。结论:QTc间期延长广泛存在于MHD患者,高FTI、低Ca、高CRP是导致QTc间期延长的独立危险因素。     

血液透析患者冠状动脉钙化的危险因素

目的 研究血液透析患者冠状动脉钙化情况,并分析其相关危险因素.方法 选择行血液透析治疗的患者201例,横断面调查所有患者血红蛋白、透析前后血清钙、血清磷、血清钾、尿素氮、肌酐、全段甲状旁腺激素、总蛋白、白蛋白、总胆固醇、甘油三酯、C反应蛋白、血清铁、铁蛋白、总铁结合力和冠状动脉钙化情况,分析冠状动脉钙化相关危险因素.结果 201例血液透析患者中发生冠状动脉钙化137例,总钙化发生率为68.2％.冠状动脉钙化组与无钙化组比较,年龄、性别、高血压、糖尿病、收缩压、脉压差、血钾、血磷、Kt/V及腰臀比差异均有统计学意义(P＜0.05).年龄、透析龄、性别、收缩压、脉压差、血钾、血磷为冠状动脉钙化的独立危险因素(P＜0.05);Kt/V为冠状动脉钙化的独立保护因素(P＜0.05).结论 血液透析患者冠状动脉钙化的发生率偏高;年龄、透析龄、性别、收缩压、脉压差、血钾、血磷为冠状动脉钙化的独立危险因素;Kt/V为冠状动脉钙化的独立保护因素.     

腹膜透析对碱性成纤维生长因子在大鼠腹膜表达的影响

腹膜超滤衰竭(UFF)是长期腹膜透析(PD)的主要并发症,而UFF患者腹膜组织病理检查显示新生血管明显增多.碱性成纤维生长因子(bFGF)是目前公认的促血管生成因子,在腹膜间皮细胞呈结构件表达.在CAPD患者腹透液中也可榆测到bFGF[1].因此,本研究探讨bFGF在腹膜组织新牛血管形成中可能的作用及机制.     

硫辛酸预处理对腹膜透析患者静脉铁剂治疗诱导的氧化应激反应的影响

目的 观察硫辛酸预处理对持续性不卧床腹膜透析(CAPD)患者接受静脉铁剂治疗诱导的急性氧化应激反应的影响.方法 40例CAPD患者先后接受单纯静脉铁剂治疗(Fe组)和先给予硫辛酸静脉滴注后的静脉铁剂治疗(Lipoic+Fe组),两次治疗间隔8周以上;分别于静脉铁剂滴注前(0时点)和滴注后10、60、120、240 min时点采集血样,可见光分光光度计测定血清超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)活性及血清丙二醛(MDA)水平.以20名健康志愿者作为正常对照组.结果 与正常对照组相比,Fe组和Lipoic+Fe组0时点血清SOD和GSH-Px活性降低,MDA水平升高(P<0.05).Fe组和Lipoic+Fe组静脉补铁后,血清SOD和GSH-Px活性下降,MDA水平升高,分别于60 min时点达到谷值或峰值.Lipoic+Fe组各时点血清SOD和GSH-Px活性均显著高于Fe组(P<0.05),MDA水平均显著低于Fe组(P<0.05).结论 静脉补铁可使CAPD患者的氧化应激状态急性加重;预防性应用硫辛酸可在一定程度上减轻静脉铁剂诱导的氧化应激反应.